Cryptococcal Meningitis: A Rare Complication in HIV-Negative Patients with Nephrotic Syndrome in A Chinese Teaching Hospital

Cryptococcal meningitis (CM) is a rare complication in HIV-negative patients with nephrotic syndrome (NS), and knowledge about the clinical profile of NS with CM is limited. We performed a retrospective study of all patients with CM-NS admitted to the Jiangxi Chest Hospital (JCH) between 2011 and 2019 and systematically reviewed cases of CM-NS reported in the Chinese language. Among a total of 226 CM patients referred to the JCH, seven had NS (3.1%); these patients were combined with 22 CM-NS cases reported in the Chinese language for analysis. Headache, fever, nausea, and meningeal irritation were the most common initial symptoms, and the median time from symptom onset to CM diagnostic confirmation was 30 days. One patient initially tested negative for CM but was later confirmed to be positive. Among the 29 analysed patients, 41.4% (12/29) were misdiagnosed with other complications, including four patients from the JCH (4/7, 57.1%) and eight patients from published reports (8/22, 36.3%). The overall mortality rate was 17.2% (5/29); among these patients, 60% (3/5) were misdiagnosed. Induction treatment with amphotericin B plus 5-fluorocytosine (9/29) or amphotericin B plus fluconazole (7/29) successfully cleared the infection. Fluconazole may be a suitable alternative if 5-fluorocytosine is not readily available or not tolerated, and repetitive testing is important to reach a conclusive diagnosis in NS patients suspected of having CM.